Healthcare in this country is a joke!

I honestly can’t believe this. Every single day, I find myself more and more baffled by the sheer absurdity of it all.
As I mentioned before, I took a nasty fall and completely wrecked my ankle. It was bad. I went to the ER and they gave me one of those plastic walking braces—an orthosis, if you want to be technical—along with the paperwork to submit to Medicare so they would cover the cost.
Thank God I live with my family; they stepped up to handle the logistics since I couldn't move an inch without being in total agony.
Fast forward one week, and I get a notice saying they’ve denied the claim because apparently, I don't "need" it? Are you kidding me?!!!!!!!😲 😲 😲
I absolutely lost it. I have no idea what logic they used to justify this rejection. I called the medical supply company, and the woman there—who was actually professional and polite, unlike the bureaucrats—told me this isn't even unusual. She mentioned she had a case where a patient couldn't even stand up straight due to spinal issues, yet Medicare still denied their equipment request. 😲
Anyway, I dragged myself down to the Medicare office today to file a formal appeal against the decision. But it doesn't end there... Today, I also filed a REQUEST FOR WRITTEN DECISION so I'll have the official documentation sent to my house, and only then can I really launch a full-scale fight against them.
Honestly, screw the healthcare system and the endless red tape. What is the point of paying into health insurance at all? I’d much rather pay a higher premium upfront if it meant actually receiving the services and rights I am entitled to when an emergency like this happens.

I can't even begin to imagine how people dealing with massive, life-altering health crises feel, especially when they don't have anyone to navigate this mindless paperwork for them.
😢

Frank Cooper47 said:🙂 🙂

Honestly, I’d give anything if this were
my favorite ugly boy—the one who’s never even had his first kiss and probably never will. Don't bother telling him he should try, because he's terrified, and we all know that fear is going to keep him from ever making a move. He's just a complete moron who spends his time harassing everyone on this forum.

Yeah, just typical Medicare bureaucracy...

Just imagine being someone with paraplegia—you have to resubmit all your medical paperwork every single year just to get approval for the basic equipment you need to survive. Then it goes to some committee, right? And this committee sits there, debating whether or not you actually have the diagnosis you claim to have, before finally deciding to "graciously" approve it again for another measly twelve months.

It’s like they think there's some miracle cure waiting around the corner to fix everything in the meantime...

rustymoose54 said:As if there’s any chance of some miraculous recovery happening in the meantime.

I suppose they need a checkbox somewhere: "Have you been on a pilgrimage in the last year? ____ Yes _____ No"

What an absolute joke. Are these commission members getting paid per approval, or is this just madness for its own sake?

Just look at this absolute nonsense. A woman—who’s pregnant, mind you—gets diagnosed with gestational diabetes. The hospital gives her some little device for free along with a starter pack of test strips, enough for four tests a day. Naturally, those run out fast, and buying a box of 100 at the pharmacy will set you back $100. So, the doctor does everything by the book and refers her to the insurance board to get a steady supply of strips covered by Medicare. Of course, the board just flat-out denies the claim.
The husband ends up buying them himself because, honestly, what else can he do? He's stuck dealing with $100 and having to monitor blood sugar levels that were constantly fluctuating—not that I want to get into all that. The pharmacist asks him why he’s buying them, pointing out that she should be entitled to them since she's pregnant.
So, he goes right back to the commission, straight to that crazy old lady who denied the request, and tells her, "Look, they told me she’s entitled to these because she's pregnant." And this woman—this total old-school busybody (probably the last of her generation, so maybe it's dementia, maybe it's pure malice, or maybe both)—just says, "Well, yes, if she's pregnant she has rights, but how was I supposed to know?"
The guy nearly lost it. "It's written right there that she's pregnant. Are you illiterate or just insane?"
She just stares at him, cold as ice: "You're being quite rude, young man (🙄). Why should I be expected to read all of that?"
Fine. In the end, the wife got her strips for free, but man, how does anyone not lose their mind dealing with a creature like that? If it hadn't been for the pharmacist, they would've been paying out of pocket, which is just a waste of money because the woman failed to do her actual job.
This happened a few months back.

Those little strips you're talking about? They're called glucose test strips—you use them with a meter to check your blood sugar levels

A box of 50 strips will run you somewhere between $300 and $133 at your local pharmacy.

If you find a pharmacy that’s actually being decent and cutting their margins to the bone, they might charge you $81 for those 50, which is basically what Medicare covers for that amount anyway.

And man, just imagine if you have insulin-dependent diabetes your whole life... if you're trying to stay somewhat healthy, you're looking at checking your levels maybe 10 to 12 times a day. But the folks over at Medicare? They only cover 4 checks a day. And even then, you have to go through some ridiculous board review every single year just to prove you haven't gone off to Lourdes or Fatima praying to the Mother of God for some miraculous cure 🙄 (meaning you're stuck paying out of pocket for those extra 6 to 8 strips every damn day)

Then, once the board finally approves your request, you've gotta trek down to the Medicare office every three months just to deal with some clerk behind the counter stamping papers... otherwise, you aren't getting anything, even if it was already approved. You grab your vouchers from your primary care doctor—who you're seeing every month regardless because she's the one writing your insulin scripts—but even she's restricted; she can't write a prescription for more than a 30-day supply. Of course, you still have to cough up $3.25 in administrative fees for the script and the vouchers, which feels like a total joke... it's like they passed these rules specifically to force people to visit the doctor less often.

There's plenty more crap to deal with, but I don't even want to get into it... I'm just getting worked up.

Look, here’s the breakdown he gave me. I’m a complete amateur when it comes to this kind of stuff, so I couldn't tell you what all the technicalities are—not that they really matter for this specific situation.
What actually matters is how these claims are processed, or more specifically, how they handled this particular case.

Michael Cox40 said:Look, these are just the details he gave me—and honestly, I’m a total amateur when it comes to this stuff, so I couldn't tell you what else is required... not that it really matters for this specific mess.
The real kicker is how they handle the claims—basically, how they handled this one specifically.

I wasn't even trying to push back on you, I was just throwing out another example to show the pattern... Your point is spot on—except that price over >$100 is actually the cost for a full box of 50.

So, here I am, getting grief for complaining for once. After dealing with a tumor, I’m stuck with checkups every three or four months—tumor markers, chest X-rays, heart scans, and CT scans of my abdomen and pelvis. And the fun begins with the CT scan; you can’t get an appointment unless you happen to know someone who knows someone... basically, you need a connection just to get seen. Otherwise, you're looking at paying about $333 out of pocket! That might not seem like much until you consider how hospitals occasionally run out of basic supplies, leaving chemo patients to hunt down their own meds at some random pharmacy for $47 per injection (apparently they need them four times a day). If they don't do that, their only choice is to spend the whole day glued to the bathroom, puking their guts out. Then there's the issue with insurance. My wife was telling me about her experience after having breast cancer; now, for preventative care, she has to get an injection every 21 days for the next year. It costs $30,000, and since there are no metastases, the insurance won't touch it—you're on your own. And of course, this all applies to people under 35! For seniors? There probably isn't even a bed left in the hospital for them!!!

rustymoose54 said:Look, I wasn't trying to nitpick your point. I was just throwing out another example to illustrate it. Your math is spot on—except for one thing. That price over >$100 is actually what you pay for a full box of 50.

I get it. Honestly, if I got any of the details wrong, it’s only because I’m just repeating what I heard from someone else. 😉

frozenpilot2 said:Honestly, I’d trade anything to have this
ugly boy be my favorite. He’s never even kissed anyone and probably never will—don't even bother telling him he should try. He’s too terrified to move, and frankly, he’s such a moron that he just makes life miserable for everyone on this forum.

Dance!!!👍

Morgan Williams4 said:Look, when you guys start complaining, don't act surprised when I vent a little too. I dealt with a tumor, and now I’m stuck going in for checkups every three or four months—just endless testing for tumor markers...

So, get this—I met a woman tonight who actually managed to drop her tumor marker levels from 2500 all the way down to 48... and she did it in about five or six months. You really have to hear her talk in person; she is absolutely glowing. 🙂

How’s that reduction process looking on your end? And for everyone else out there, what has your experience been like with stuff like this?

rustymoose54 said:Just imagine having insulin-dependent diabetes your entire life...

Honestly, I can't even wrap my head around that—especially knowing how much of a fixable issue it is after just a few months (and I’m talking Type II here).

Honestly, don't even let it get to you—you can tell right away he’s just one of those guys who pops into the health sub to try and hawk his "miracle cures"...

frozenpilot2 said:I went to the ER and they gave me one of those plastic mobile splints (the technical term is an orthosis), along with a prescription to take to Medicare so they can cover the costs.
😢

It’s not a "langeta," it’s a LONG-eta!
Just a small correction... 👋

rustymoose54 said:Those strips you’re talking about—they're called blood glucose test strips used with a meter.

A box of 50 usually runs anywhere from $300 to $133 at a standard pharmacy.

Even if you find a pharmacy that really cuts their margins to the bone, they’ll charge you $81 for those 50 strips, which is exactly what Medicare covers for that amount.

Now, just imagine living with insulin-dependent diabetes your entire life—you'd be checking your levels maybe 10 to 12 times a day just to stay relatively healthy. The bureaucrats over at Medicare only cover 4 checks a day. And even then, you have to go before a medical board every single year just to prove you haven't gone off to Lourdes or Fatima praying for some miracle from the Mother of God to magically cure you 🙄 (meaning you're stuck paying for the remaining 6 to 8 strips a day out of your own pocket).

I actually dealt with this exact nonsense at home recently. 😢
The level of stupidity in our healthcare bureaucracy is endless—honestly, I just hope I never get seriously ill in this godforsaken country. If I do, I'll be at the mercy of some politically appointed doctors who operate with the same level of competence as a clerk at the local Social Security office reading a manual.

I use a private gynecologist who isn't cheap, but I'm still registered with the public system because, well, you have to be enrolled somewhere. That same public system is supposed to provide my prescription medications... however, the way the nurse brushed me off over the phone was: "Ma'am, if you can afford private doctors, then surely you can afford to buy your own medicine."

There is just so much absurdity... I don't even know if there's any point in discussing it anymore.

Christian Sanchez44 said:The sheer amount of nonsense within the healthcare bureaucracy is endless—honestly, I just find myself praying I never actually get sick in this godforsaken country. Imagine falling into the hands of some lethargic, politically appointed doctor who operates with all the precision and care of a clerk at the local Medicare office reading through paperwork.

But we can't just sit around crossing our fingers and hoping for the best; we actually need to take some kind of action to prepare for it. 😉 😎

Christian Sanchez44 said:That same person is supposed to be the one filling my prescriptions... but the way the nurse just brushed me off over the phone was basically, "Look lady, if you can afford private doctors, then I guess you can afford to buy your own meds too."

Sorry, Christian Sanchez44—and look, I really respect you—but you are being incredibly, incredibly wrong here. What you’re describing isn't a failure of the entire healthcare system... it’s just one nurse being arrogant and rude.
I know plenty of women who have "public" OBGYNs who will happily write out prescriptions they just copied from a private specialist (I actually heard about this recently on another thread, looked into it, and realized it's actually pretty common practice)...

I honestly think it's a huge mistake—and kind of unfair—to take one person's bad attitude and pin it on the whole medical system.

I have to side with Jose Miller3 on this one. You really need to ditch that doctor—the one you see through Medicare. It’s become way too common at those clinics for them to just hand out prescriptions regardless of whether you're actually seeing a private specialist or not.

Switching your primary care doctor or some "socialized" GP isn't the fix—we need systemic reform.
Medicare acts as a total monopolist, whether you’re looking at drug manufacturers or contracted physicians. There is a massive disconnect between what is told to the public and what those actually working in healthcare experience day in and day out.
Even the core concept of collective solidarity—where every patient holds the same rights regardless of their contribution level—is fundamentally broken.
It seems like the rest of the West realized this a long time ago. Somehow, we’ve managed to stay stuck in this loop, doing nothing but complaining and venting without actually fixing anything.😈

Look, I’m on the same page as everything you just laid out. But here’s the reality: finding a decent "public" GP who doesn't have a waiting room backed up for half a day is nearly impossible. Because of that, women end up opting for private clinics instead. Then, those who are conscious of how the system works usually just ask the public doctor to transcribe the prescriptions they already got from the private one.
If the GP Christian Sanchez44 is using isn't part of that group, then the solution is simple: find a new one.
I hope that clarifies my point.

As for all this complaining and general passivity, it’s the same story in every sector. In my opinion, the people best equipped to actually fix things are the ones working within those systems. 😉